Endoscopic treatment device

ABSTRACT

An endoscopic treatment device includes a sheath formed from a resin; a tubular hollow needle inserted into the sheath and having a sharp distal end; a rod formed from a metal and having a conduit; a shaft attached to a proximal end of the rod and having an internal space communicating with the conduit of the rod; and an operation portion including (i) a slider attached to a proximal end of the shaft, and (ii) and a lever attached to a proximal end of the hollow needle.

CROSS-REFERENCE TO RELATED APPLICATION

This nonprovisional application claims the benefit of U.S. Provisional Application No. 63/143,141, filed Jan. 29, 2021. The disclosure of the prior application is hereby incorporated by reference herein in its entirety.

TECHNICAL FIELD

The present disclosure relates to an endoscopic treatment device.

BACKGROUND

Conventionally, during an endoscopic treatment such as Endoscopic Submucosal Dissection (ESD) or the like, the endoscopic treatment device for dissection and peeling procedures (such as the high-frequency knife and the like), the endoscopic treatment device for local injection procedures, and the endoscopic treatment device for hemostasis procedures are used.

The endoscopic treatment devices can be configured to be capable of performing several procedures among the dissection and the peeling procedures, the local injection procedures, and the hemostasis procedures. For example, the endoscopic high-frequency treatment device can be capable of performing the dissection procedures, the peeling procedures, and the hemostasis procedures. Or it can be capable of performing the dissection procedures, the peeling procedures, and the local injection procedures.

SUMMARY

In some embodiments of the present disclosure, an endoscopic treatment device includes a sheath formed from a resin; a tubular hollow needle inserted into the sheath and having a sharp distal end; a rod formed from a metal and having a conduit; a shaft attached to a proximal end of the rod and having an internal space communicating with the conduit of the rod; and an operation portion including (i) a slider attached to a proximal end of the shaft, and (ii) a lever attached to a proximal end of the hollow needle.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an overall view showing an endoscopic treatment system according to an exemplary embodiment.

FIG. 2 is an overall view showing a treatment device of the endoscopic treatment system.

FIG. 3 is a perspective view showing a distal end portion of the treatment device.

FIG. 4 is a side view showing the distal end portion of the treatment device.

FIG. 5 is a cross-sectional view showing the distal end portion of the treatment device.

FIG. 6 is a cross-sectional view showing the distal end portion of the treatment device.

FIG. 7 is a cross-sectional view showing an operation portion of the treatment device.

FIG. 8 is a view showing a connection between a lever of the operation portion and a sharp member.

FIG. 9 is a cross-sectional view of the operation portion along line X-X shown in FIG. 8.

FIG. 10 is a view showing the treatment device when the lever is moved to a distal end side with respect to a slider of the operation portion.

FIG. 11 is a view showing the treatment device when the lever is moved to a proximal end side with respect to the slider of the operation portion.

FIG. 12 is a cross-sectional view showing a modification example of the operation portion.

FIG. 13 is a view showing a modification example of a flange of the treatment device.

FIG. 14 is a view showing a modification example of a rod of the treatment device.

FIG. 15 is a view showing a modification example of the treatment device.

FIG. 16 is a cross-sectional view of the modification example.

FIG. 17 is a cross-sectional view of the modification example.

FIG. 18 is an overall view showing a treatment device according to an exemplary embodiment.

FIG. 19 is a perspective view showing a distal end portion of the treatment device.

FIG. 20 is a side view showing the distal end portion of the treatment device.

FIG. 21 is a cross-sectional view showing the distal end portion of the treatment device.

FIG. 22 is a cross-sectional view showing the distal end portion of the treatment device.

FIG. 23 is a cross-sectional view showing an operation portion of the treatment device.

FIG. 24 is a cross-sectional view showing the operation portion of the treatment device.

FIG. 25 is a view showing a modification example of a flange of the treatment device.

FIG. 26 is a view showing a modification example of a rod of the treatment device.

FIG. 27 is a view showing another modification example of the rod of the treatment device.

FIG. 28 is a cross-sectional view showing a modification example of the treatment device.

FIG. 29 is a cross-sectional view showing a modification example of the treatment device.

DESCRIPTION OF EMBODIMENTS

An endoscopic treatment system 300 according to an exemplary embodiment of the present disclosure will be described by referring to FIG. 1 to FIG. 17. FIG. 1 is an overall view of the endoscopic treatment system 300 according to the present embodiment.

[Endoscopic Treatment System 300]

As shown in FIG. 1, the endoscopic treatment system 300 includes an endoscope 200 and a treatment device 100. The treatment device 100 is inserted into the endoscope 200 to be used.

[Endoscope 200]

The endoscope 200 is a conventional flexible endoscope, and includes an insertion portion 202 being inserted into the body from a distal end, and an operation portion 207 attached to a proximal end of the insertion portion 202.

The insertion portion 202 includes an imaging portion 203, a bending portion 204, and a flexible portion 205. The imaging portion 203, the bending portion 204, and the flexible portion 205 are disposed from the distal end of the insertion portion 202 in this sequence. Inside the insertion portion 202, a channel 206 for inserting the treatment device 100 is provided. A distal end opening portion 206 a of the channel 206 is provided at the distal end of the insertion portion 202.

The imaging portion 203 includes, for example, the imaging element such as CCD or CMOS, and is configured to be able to image the site of the treatment target. The imaging portion 203 is able to image the rod 2 of the treatment device 100 in a state in which the treatment device 100 protrudes from the distal end opening portion 206 a of the channel 206.

The bending portion 204 is bent according to operations by an operator to the operation portion 207. The flexible portion 205 is a tubular portion having flexibility.

The operation portion 207 is connected to the flexible portion 205. The operation portion 207 includes a grip 208, an input portion 209, a proximal end opening portion 206 b of the channel 206, and a universal cord 210. The grip 208 is a portion for the operator to grasp. The input portion 209 receives the operation input for the bending operations of the bending portion 204. The universal cord 210 is configured to output the image captured by the imaging portion 203 to the external device. The universal cord 210 is connected to a display device such as an LCD display or the like via an image processing device that includes a processor and the like.

[Treatment Device 100]

FIG. 2 is an overall view of the treatment device 100C.

The treatment device (endoscopic treatment device) 100 includes a sheath 1, a rod 2, a sharp member (hollow needle) 3, an operation wire 4 (see FIG. 5), and an operation portion 5. In the following description, along a longitudinal direction A of the treatment device 100, the side being inserted into the body of the patient is referred to as the “distal end side A1”, and the side of the operation portion 5 is referred to as the “proximal end side A2”.

The sheath 1 having flexibility and insulation properties is an elongated member extending from a distal end 1 a to a proximal end 1 b and the sheath 1 is made from a resin material. The sheath 1 has an outer diameter so as to be insertable into the channel 206 of the endoscope 200, and is advanceable and retractable in the channel 206. As shown in FIG. 1, in a state in which the sheath 1 is inserted into the channel 206, the distal end 1 a of the sheath 1 is able to protrude from the distal end opening portion 206 a of the channel 206.

FIG. 3 is a cross-sectional view of a distal end of the treatment device 100.

An insulation tip (distal end cover) 11 including a penetration hole 12 penetrating along the longitudinal direction A is attached to the distal end 1 a of the sheath 1. The rod 2 and the sharp member 3 are inserted into the penetration hole 12.

FIG. 4 is a side view of the distal end of the treatment device 100.

The rod 2 is a member formed from a metal material and has an approximately round bar shape. The rod 2 is provided to be able to protrude from the penetration hole 12 of the insulation tip 11 of the sheath 1 toward the distal end side (A1). For example, the rod 2 is formed from a material such as stainless steel or the like. The rod 2 has conductivity to be energized by a high-frequency current. The rod 2 includes a rod main body 20 and a flange 21.

The rod 2 is inserted through the tubular sharp member 3 along the longitudinal direction A, and the rod 2 is relatively movable with respect to the sharp member 3. A central axis O2 along the longitudinal direction A of the rod 2 is substantially coincided with the central axis O1 along the longitudinal direction A of the sheath 1.

FIG. 5 is a cross-sectional view showing a distal end portion of the treatment device 100.

The rod main body 20 is a member formed from the metal material and in a round bar shape. The rod main body 20 is configured to supply the high-frequency current supplied from the operation wire 4 connected to the operation portion 5 to the flange 21. When the high-frequency current is supplied from the operation wire 4 to the rod 2, the rod main body 20 and the flange 21 function as the monopolar electrode configured to output the high-frequency current to the living tissues.

The flange 21 is a disk-shaped conductive member provided at the distal end of the rod main body 20. In a front view seen from the direction along the longitudinal direction A, the outer circumference of the flange 21 is formed in a concentric circular shape with the outer circumference of the rod main body 20. As shown in FIG. 4, a length L1 of the flange 21 in a radial direction R orthogonal to the longitudinal direction A is longer than a length L2 of the rod main body 20 in the radial direction R.

The rod 20 and the flange 21 include a first water-supply pipeline 22 extending along the longitudinal direction A. The first water-supply pipeline 22 communicates with the distal end opening 22 a formed at the flange 21. The distal end opening 22 a opens at the distal end side (A1).

The sharp member (hollow needle) 3 is a tubular member formed from the resin material, the metal material or the like. The rod 2 and the operation wire 4 are inserted through the internal space 3 s of the sharp member 3 to be advanceable and retractable. The sharp member 3 includes a tubular main body portion 31, a distal end portion 32 and a sharp portion 33.

The tubular main body portion 31 is a cylindrical member having a proximal end connected to the operation portion 5. The distal end portion 32 is provided at the distal end of the tubular main body portion 31.

The distal end portion 32 is provided at the distal end of the tubular main body portion 31, and the distal end portion 32 is formed in a semi-cylindrical shape by dividing the cylindrical member along the longitudinal direction A. In other words, the distal end portion 32 includes a slit formation portion 32 a formed in the semi-cylindrical shape. A portion of the flange 21 protrudes outwardly in the radial direction from the outer circumferential surface and/or the inner circumferential surface of the tubular main body portion 31. The flange 21 is configured to be freely slidable at the distal end side of the proximal end 32 b of the slit formation portion 32 a. It is not necessary for the slit formation portion 32 a to be in the semi-cylindrical shape, and for example, the slit formation portion 32 a may be configured as the groove with a width smaller than the inner diameter of the tubular main body portion 31 that is formed along the longitudinal axis. In this case, the flange 21 is formed to have the dimension capable of entering the groove so as to be slidable inside the groove.

The sharp portion 33 is provided at the distal end of the distal end portion 32, and the distal end side (A1) of the sharp portion 33 is sharp (configured to incise or penetrate a living tissue). The sharp portion 33, as shown in FIG. 3 and FIG. 4, is formed to have a shape that an edge 33 a at the distal end side (A) of the semi-cylindrical shape is inclined with respect to the longitudinal direction A. The distal end (needle tip) 33 b of the sharp portion 33 is formed to be sharp toward the distal end side (A1).

FIG. 6 is a cross-sectional view showing the distal end portion of the treatment device 100.

The rod 2 and the sharp member 3 can be accommodated in the proximal end side (A2) from the penetration hole 12 of the insulation tip 11 of the sheath 1 by being retracted.

The operation wire 4 is a shaft inserting through the internal space 3 s of the sharp member 3, and the operation wire 4 includes a coil shaft 40 and a tube 41. The distal end of the operation wire 4 is connected to the rod 2, and the proximal end of the operation wire 4 is connected to the operation portion 5. The operation wire 4 only has to be a hollow shaft, but can otherwise be configured in other configurations.

The coil shaft 40 is a coil wire made from a metal material. For example, the coil shaft 40 is made from a material such as stainless steel or the like. Inside the coil shaft 40, a second water-supply pipeline 42 is formed. The second water-supply pipeline 42 is connected to the proximal end of the first water-supply pipeline 22.

The tube 41 is a tube provided in the outer circumferential portion of the coil shaft 40, and for example, the tube 41 is a heat shrinkable tube. By covering the tube 41 on the outer circumferential portion of the coil shaft 40, there is no liquid leakage from the second water-supply pipeline 42.

As shown in FIG. 1 and FIG. 2, the operation portion 5 includes an operation portion main body 51, a slider 52, a power-supply connector 53, a liquid-supply port 54, and a lever (second slider) 55.

FIG. 7 is a cross-sectional view showing the operation portion 5.

The distal end portion of the operation portion main body 51 is connected to the proximal end 1 b of the sheath 1. The operation portion main body 51 has an internal space into which the operation wire 4 can be inserted. The sharp member 3 and the operation wire 4 extend until the slider 52 through the internal space 1 s of the sheath 1 and the internal space 5 s of the operation portion main body 51.

The slider 52 is attached thereto to be movable along the longitudinal direction A with respect to the operation portion main body 51. The slider 52 is attached to the sheath 1 connected to the operation portion main body 51 via the O-ring 52 a. The proximal end 4 b of the operation wire 4 is attached to the slider 52. The operation wire 4 and the rod 2 advance and retract by the surgeon relatively advancing and retracting the slider 52 with respect to the operation portion main body 51.

The power-supply connector 53 is fixed to the slider 52. The power-supply connector 53 is connectable with the high-frequency power supply device which is not shown in the figures, and the power-supply connector 53 is connected to the proximal end portion of the operation wire 4 via a conductive wire 53 w. The power-supply connector 53 is configured to be able to supply the high-frequency current supplied from the high-frequency power supply device to the rod 2 via the operation wire 4.

The liquid-supply port 54 is provided on the slider 52. The liquid-supply port 54 is connected to the proximal end of the second water-supply pipeline 42 via a third water-supply pipeline 56 formed in the slider 52. The liquid supplied from the liquid-supply port 54 passes through the third water-supply pipeline 56, the second water-supply pipeline 42, and the first water-supply pipeline 22 and is drained from the distal end opening 22 a.

FIG. 8 is a view showing a connection between the lever 55 and the sharp member 3.

The proximal end of the sharp member 3 is attached to the lever (second slider) 55. The lever (second slider) 55 is attached to the slider 52 to be movable along the longitudinal direction A. The lever 55 includes a handle portion 55 a in a convex shape and operated by the surgeon, and an engagement portion 55 b connected to the sharp member 3. An engagement convex portion 55 c is provided in the distal end of the engagement portion 55 b.

As shown in FIG. 8, a penetration hole 13 extending along the longitudinal direction A is formed in the sheath 1. The lever 55 passes through the penetration hole 13 and is connected to the sharp member 3.

FIG. 9 is a cross-sectional view of the operation portion 5 along the line X-X shown in FIG. 8.

As shown in FIG. 8 and FIG. 9, an engaged portion 34 engaging with the engaging portion 55 b is formed in the proximal end portion of the sharp member 3. An engaging concave portion 34 a that engages with the engaging convex portion 55 c is formed in the engaged portion 34.

FIG. 10 is a view showing the treatment device 100 in which the lever 55 is moved to the distal end side (A1) with respect to the slider 52. By moving the lever 55 to the distal end side (A1) with respect to the slider 52, the sharp portion 33 of the sharp member 3 is moved to the distal end side (A1) with respect to the rod 2 connected to the operation wire 4 fixed to the slider 52.

FIG. 11 is a view showing the treatment device 100 in which the lever 55 is moved to the proximal end side (A2) with respect to the slider 52. By moving the lever 55 to the proximal end side (A2) with respect to the slider 52, the sharp portion 33 of the sharp member 3 is moved to the proximal end side (A2) with respect to the rod 2 connected to the operation wire 4 fixed to the slider 52.

As shown in FIG. 7, the operation wire 4 is embedded in the sharp member 3. Accordingly, when the operation wire 4 and the rod 2 advance and retract by the surgeon relatively advancing and retracting the slider 52 with respect to the operation portion main body 51, the sharp member 3 also advances and retracts due to the friction.

[Usage Method of Treatment Device 100C]

Next, the procedures using the endoscopic treatment system 300 (usage method of the endoscopic treatment system 300) according to the present embodiment will be described. More specifically, the dissection and the peeling procedures, the local injection procedures, and the hemostasis procedures such as the ESD (Endoscopic Submucosal Dissection) procedures or the like with respect to the lesion site during the endoscopic treatment will be described.

As a preparation operation, the surgeon uses the conventional method to specify the lesion site. More specifically, the surgeon inserts the insertion portion 202 of the endoscope 200 into the gastrointestinal tract (such as the esophagus, the stomach, the duodenum, and the large intestine) to specify the lesion site while observing the image captured by the imaging portion 203 of the endoscope.

<Insertion Step>

The surgeon inserts the treatment device 100 into the channel 206 and protrudes the distal end 1 a of the sheath 1 from the distal end opening portion 206 a of the insertion portion 202. The surgeon relatively advances the slider 52 of the operation portion 5 with respect to the operation portion main body 51 to protrude the rod 2 and the sharp member 3.

<Local Injection Step>

As shown in FIG. 10, the surgeon moves the lever 55 to the distal end side (A1) with respect to the slider 52 to move the sharp member 3 to the distal end side (A1) with respect to the rod 2. As a result, the sharp portion 33 of the sharp member 3 protrudes toward the distal end side (A1) with respect to the rod 2. The surgeon sticks and penetrates the location where the liquid for the local injection (local injection solution) at the lesion site using the sharp portion 33 of the sharp member 3. More specifically, the surgeon forms an incision from the mucosa surface until the submucosa layer by the distal end (needle tip) 33 b of the sharp portion 33. The surgeon supplies liquid to the submucosa layer in a state of putting the distal end opening 22 a at the distal end of the rod 2 into the submucosa layer (local injection step). More specifically, the surgeon supplies the liquid from the distal end opening (hole) 22 a toward the incision in a state in which the sharp portion 33 of the sharp member 3 is stuck into the incision. The surgeon inflates the mucosa surface by injecting the liquid until the submucosa layer from the distal end opening 22 a via the incision. The surgeon may supply the liquid from the distal end opening 22 a toward the incision in a state in which the distal end of the rod 2 is pressed on the incision.

<Dissection and the Peeling Step>

The surgeon performs the dissection and peeling procedures. As shown in FIG. 11, the surgeon advances the rod 2 to move the flange 21 in an energized state by the high-frequency current to dissect the mucosa on the lesion site. Otherwise, the surgeon advances the rod 2 to lift the dissected mucosa at the lesion site to expose the submucosa layer and peels off the submucosa layer in the dissected lesion site. During the dissection and peeling procedures, it is desirable that the sharp member 3 is completely accommodated in the sheath 1.

<Additional Local Injection Step>

The surgeon performs the additional local injection procedures as needed. As shown in FIG. 10, the surgeon protrudes the sharp portion 33 of the sharp member 3 toward the distal end side (A1) with respect to the rod 2. The surgeon sticks and penetrates the location where the liquid for the local injection (local injection solution) at the lesion site using the sharp portion 33 of the sharp member 3 (additional local injection step).

<Hemostasis Procedures>

In a case in which bleeding occurs during the dissection and peeling procedures, the surgeon performs the hemostasis procedures. The surgeon presses the rod main body 20 and the flange 21 on the bleeding point while cauterizing the bleeding point by energization with the high-frequency current to stop the bleeding (hemostasis step).

The surgeon continues the above-described operations (procedures) as needed so as to finally dissect the lesion site and finish the ESD procedures.

According to the treatment device 100 disclosed in the present embodiment, it is possible to perform various procedures such as the local injection procedures, the dissection and the peeling procedures, and the hemostasis procedures.

An exemplary embodiment of the present disclosure has been described above; however, the specific configuration thereof is not limited to this specific configuration, and modifications within the scope of the claims and not departing from the spirit of the present disclosure may be included. Also, the configuration may be made by appropriately combining the configurations disclosed in the above-described embodiment and modification examples.

Modification Example 1-1

In the above-described embodiment, the slider 52 and the lever 55 are not directly connected to each other in the operation portion 5. However, the configuration of the operation portion 5 is not limited thereto. FIG. 12 is a cross-sectional view showing an operation portion 5A as a modification example of the operation portion 5. The operation portion 5A includes the operation portion main body 51, a slider 52A, the power-supply connection 53, the liquid-supply port 54, and a lever 55A. The slider 52A and the lever 55A are connected to each other by a ratchet mechanism.

Compared with the lever 55 according to the first embodiment, the lever 55A further includes a spring 55 s, an engaging portion (claw) 55 e, and a release button 55 r. Compared with the slider 52 according to the first embodiment, the slider 52A further includes an engaged portion (ratchet teeth) 52 e.

The engaging portion 55 e of the lever 55A engages with the engaged portion (ratchet teeth) 52 e provided in the slider 52A due to the restoring force of the spring 55 s. In the case in which the engaging portion 55 e is engaged with the engaged portion 52 e, it is impossible for the lever 55A to advance with respect to the slider 52A. On the other side, even in the case in which the engaging portion 55 e is engaged with the engaged portion 52 e, it is possible for the lever 55A to retract with respect to the slider 52A.

The release button 55 r is configured to release the engagement of the engaging portion 55 e and the engaged portion 52 e. The release button 55 r can move to two positions including a standard position and a press position being pressed from the standard position. The release button 55 r includes a lock mechanism such that the release button 55 r moved to the press position is kept in the press position until the release button is pressed next time. The surgeon moves the release button 55 r from the press position to the standard position so as to make the lever 55A be advanceable with respect to the slider 52A. In other words, the engagement (catching) between the engaging portion 55 e and the engaged portion 52 e is disengaged by moving the release button 55 r to the standard position such that the lever 55A is advanceable with respect to the lever 55A.

According to the operation portion 5A, the slider 52A and the lever 55A are connected to each other by the ratchet mechanism such that it is possible to operate the sharp member 3 and the operation wire 4 in conjunction except in the case in which the connection is released. Accordingly, it is possible to prevent the sharp member 3 from unintentionally protruding toward the rod 2.

Modification Example 1-2

In the above-described embodiment, the flange 21 in a disk shape is provided at the distal end of the rod 2. However, the configuration of the flange 21 is not limited thereto. FIG. 13 is a view showing a flange 21A as a modification example of the flange 21. The flange 21A is formed in a triangle shape when viewed in a front view from the distal end side (A1).

Modification Example 1-3

In the above-described embodiment, the flange 21 is provided at the distal end of the rod 2. However, the configuration of the rod 2 is not limited thereto. FIG. 14 is a view showing a rod 2A as a modification example of the rod 2. A distal end portion 24 of the rod 2A is formed in a hook shape. The distal end opening 22 a that opens toward the distal end side (A1) is formed in the distal end portion 24.

Modification Example 1-4

FIG. 15 to FIG. 17 are views showing a treatment device 100E as a modification example of the treatment device 100.

The treatment device 100E includes a sheath 1E, a rod 2E, a sharp member (hollow needle) 3E, the operation wire 4, and the operation portion 5.

Similar to the sheath 1, the sheath 1E is an elongated member and formed from the resin, and the sheath 1E includes the insulation tip (distal end cover) 11E as a modification example of the insulation tip 11. Compared with the insulation tip (distal end cover) 11, the insulation tip (distal end cover) 11E further includes a restriction member 14. As shown in FIG. 15, the restriction member 14 is a member configured to block part of the penetration hole 12. As shown in FIG. 16, the flange 21 of the retracting rod 2E comes into contact with the distal end of the restriction member 14 of the insulation tip 11E such that it is impossible for the distal end of the rod 2E to enter the inside space 1 s of the sheath 1E. The position of the distal end of the rod 2E is determined to be at the second position P2 at the proximal end side (A2, base end side) of the needle tip 33 b of the sharp member 3E.

Similar to the rod 2, the rod 2E is the member in the substantially round bar shape and made from the metal material, and the rod 2E further includes a connection portion 23 connecting with the operation wire 4. The connection portion 23 is configured to connect the proximal end of the rod 2E and the distal end of the operation wire 4. The connection portion 23 protrudes from the rod 2E outwardly in the radial direction. As shown in FIG. 17, the connection portion 23 of the advancing rod 2E comes into contact with the proximal end of the restriction member 14 such that the position of the distal end of the rod 2E is determined to be at the first position P1 at the distal end (A1, front end side) of the needle tip 22 b of the sharp member 3E.

The sharp member (hollow needle) 3E is the tubular member formed of the same resin material or the metal material as the same with that of the sharp member 3, and the sharp member 3E further includes a protrusion 36 protruding in the radial direction on the outer circumferential surface of the distal end portion 32. As shown in FIG. 16, the position of the distal end of the sharp member 3E is determined by the protrusion 36 of the advancing sharp member 3E comes into contact with the proximal end of the insulation tip 11E.

A treatment device 100B according to another exemplary embodiment of the present disclosure will be described by referring to FIG. 18 to FIG. 24. In the following description, the described common configurations will be designated with the same reference signs and the duplicate description will be omitted.

[Treatment Device 100B]

FIG. 18 is an overall view showing the treatment device 100B.

Similar to the treatment device 100 according to the above embodiment, the treatment device (endoscopic treatment device) 100B together with the endoscope 200 configure the endoscopic treatment system. The treatment device 100B includes the sheath 1, a rod 2B, a sharp member (hollow needle) 3B, an operation wire 4B, and an operation portion 5B.

FIG. 19 is a perspective view showing the distal end portion of the treatment device 100B.

The rod 2B and the sharp member 3B are inserted into the penetration hole 12 formed in the insulation tip (distal end cover) 11 of the sheath 1.

FIG. 20 is a side view showing the distal end portion of the treatment device 100B.

Similar to the rod 2 according to the above embodiment, the rod 2B is a tubular member made from the metal material, and the rod 2B is configured to be able to protrude toward the distal end side (A1) from the penetration hole 12 of the insulation tip 11 of the sheath 1. The rod 2B has conductivity and is energized by the high-frequency current. The rod 2B includes the rod main body 10 and the flange 21.

When the high-frequency current is supplied from the operation wire 4B to the rod 2B, the rod main body 20 and the flange 21 function as a monopolar electrode configured to output high-frequency current to the living tissues.

FIG. 21 is a cross-sectional view showing the distal end portion of the treatment device 100B.

The rod 2B includes an internal space 2 s extending along the longitudinal direction A. The internal space 2 s communicates with the distal end opening 22 a formed in the flange 21. The distal end opening 22 a opens toward the distal end side (A1).

Similar to the sharp member 3 according to the first embodiment, the sharp member (hollow needle) 3B is the tubular member formed from the resin material, the metal material or the like. The sharp member 3B includes the tubular main body portion 31 and the sharp portion 33B.

The sharp member 3B includes the water-supply pipeline 35 extending along the longitudinal direction A. The water-supply pipeline 35 communicates with the distal end opening 35 a formed in the sharp portion 33B. The distal end opening 35 a opens toward the distal end side (A1).

The sharp member 3B is inserted through the internal space 2 s of the rod 2B along the longitudinal direction A, and the sharp member 3B is relatively movable with respect to the rod 2B. The central axis O2 along the longitudinal direction A of the rod 2B is substantially coincided with the central axis O1 of the sheath 1 along the longitudinal direction A.

The sharp portion 33B is a sharp member provided at the distal end of the tubular main body portion 31 and being sharp at the distal end thereof. As shown in FIG. 19 and FIG. 20, the sharp portion 33B is formed to have the edge 33 a at the distal end side with the cylindrical shape to be inclined with respect to the longitudinal direction A. The distal end 33 b of the sharp portion 33B is formed to be sharp toward the distal end side (A1).

FIG. 22 is a cross-sectional view showing the distal end portion of the treatment device 100B.

The rod 2B and the sharp member 3B can be accommodated at the proximal end side (A2) of the insulation tip 11 of the sheath 1 from the penetration hole 12 as being retracted.

The operation wire 4B is the shaft inserted through the internal space 1 s of the sheath 1, and the operation wire 4B has the coil shaft 40. The sharp member 3B is inserted through the internal space 4 s of the operation wire 4B to be freely advanceable and retractable. The distal end of the operation wire 4B is connected to the rod 2B, and the proximal end of the operation wire 4B is connected to the operation portion 5B. The operation wire 4B only has to be a hollow shaft, but may otherwise be configured according to other configurations.

As shown in FIG. 18, the operation portion 5B includes the operation portion main body 51, the slider 52, the power-supply connector 53, the liquid-supply port 54, and the lever (second slider) 55.

FIG. 23 is a cross-sectional view showing the operation portion 5B.

The distal end portion of the operation portion main body 51 is connected to the proximal end 1 b of the sheath 1. The operation portion main body 51 has an internal space into which the operation wire 4B can be inserted. The sharp member 3B and the operation wire 4B extend until the slider 52 through the internal space 1 s of the sheath 1 and the internal space 5 s of the operation portion main body 51.

The proximal end 4 b of the operation wire 4B is attached to the slider 52. The operation wire 4B and the rod 2B advance and retract by the surgeon relatively advancing and retracting the slider 52 with respect to the operation portion main body 51.

The power-supply connector 53 is fixed to the slider 52. The power-supply connector 53 is connectable with the high-frequency power supply device which is not shown in the figures, and the power-supply connector 53 is connected to the proximal end portion of the operation wire 4B via the conductive wire 53 w. The power-supply connector 53 is configured to be able to supply the high-frequency current supplied from the high-frequency power supply device to the rod 2B via the operation wire 4B.

The liquid-supply port 54 is provided on the slider 52. The liquid-supply port 54 is connected to the proximal end of the water-supply pipeline 35 via the third water-supply pipeline 56 formed in the slider 52. The liquid supplied from the liquid-supply port 54 passes through the third water-supply pipeline 56 and the water-supply pipeline 35 and is drained from the distal end opening 35 a.

FIG. 24 is a cross-sectional view of the operation portion 5B.

The proximal end of the sharp member 3B is attached to the lever (second slider) 55. The lever (second slider) 55 is attached to the slider 52 to be movable along the longitudinal direction A. The lever 55 is connected to the sharp member 3B through the penetration hole 13.

By moving the lever 55 to the distal end side (A1) with respect to the slider 52, the sharp portion 33B of the sharp member 3B is moved to the distal end side (A1) with respect to the rod 2B connected to the operation wire 4B fixed to the slider 52.

By moving the lever 55 to the proximal end side (A2) with respect to the slider 52, the sharp portion 33B of the sharp member 3B is moved to the proximal end side (A2) with respect to the rod 2B connected to the operation wire 4B fixed to the slider 52.

As shown in FIG. 23, the sharp member 3B is embedded in the operation wire 4B. Accordingly, when the operation wire 4B and the rod 2B advance and retract by the surgeon relatively advancing and retracting the slider 52 with respect to the operation portion main body 51, the sharp member 3B also advances and retracts due to the friction. Similar to the modification example 1-1 of the first embodiment, the slider 52 and the lever 55 may be engaged with each other to be relatively slidable with each other by the ratchet mechanism or the like. Accordingly, the slider 52 and the lever 55 are able to be advanced and retracted simultaneously.

According to the treatment device 100B disclosed in the present embodiment, it is possible to perform various procedures such as the local injection procedures, the dissection and the peeling procedures, and the hemostasis procedures by the same usage method of the treatment device 100 according to the present embodiment.

Another embodiment of the present disclosure has been described above; however, the specific configuration thereof is not limited to this specific configuration, and modifications within the scope of the claims and not departing from the spirit of the present disclosure may be included. Also, the configuration may be made by appropriately combining the configurations disclosed in this embodiment and modification examples.

Modification Example 2-1

In the above-described embodiment, the flange 21 in the disk shape is provided at the distal end of the rod 2B. However, the configuration of the flange 21 is not limited thereto. FIG. 25 is a view showing the flange 21A as a modification example of the flange 21. The flange 21A is formed in a triangle shape when viewed in a front view from the distal end side (A1).

Modification Example 2-2

In the above-described embodiment, the flange 21 is provided at the distal end of the rod 2B. However, the configuration of the rod 2B is not limited thereto. FIG. 26 is a view showing a rod 2Ba as a modification example of the rod 2B. The distal end portion 24 of the rod 2Ba is formed in a hook shape. The distal end opening 22 a that opens toward the distal end side (A1) is formed in the distal end portion 24.

Modification Example 2-3

In the above-described embodiment, the flange 21 is provided at the distal end of the rod 2B. However, the configuration of the rod 2B is not limited thereto. FIG. 27 is a view showing a rod 2Bb as a modification example of the rod 2B. The distal end portion 25 of the rod 2Bb is formed in a hemisphere shape. The distal end opening 22 a that opens toward the distal end side (A1) is formed in the distal end portion 25.

Modification Example 2-4

FIG. 28 to FIG. 29 are views showing a treatment device 100F as a modification example of the treatment device 100.

The treatment device 100F includes the sheath 1, a rod 2F, a sharp member (hollow needle) 3F, the operation wire 4B, and the operation portion 5B.

Similar to the rod 2B, the rod 2F has a substantially round bar shape and is made from the metal material, and the rod 2F includes a rod main body 20F, a flange 21F, and the connection portion 23. Similar to the rod main body 20, the rod main body 20F has a round bar shape and is made from the metal material, and the rod main body 20F further includes a groove 24 extending along the longitudinal direction A. The groove 24 is configured to penetrate the rod main body 20F from the internal circumferential surface to the outer circumferential surface of the rod main body 20F. The flange 21F has a larger outer diameter than that of the flange 21. As shown in FIG. 28, since the flange 21F of the retracting rod 2F comes into contact with the distal end of the insulation tip 11, the distal end of the rod 2F is impossible to enter the internal space 1 s of the sheath 1. The connection portion 23 protrudes outwardly from the rod 2F in the radial direction. As shown in FIG. 29, the connection portion 23 of the advancing rod 2F comes into contact with the proximal end of the insulation tip 11 so as to determine the position of the distal end of the rod 2F.

Similar to the sharp member 3, the sharp member (hollow needle) 3F is a tubular member formed from the resin material, the metal material or the like, and the sharp member 3F further includes the protrusion 36 protruding from the outer circumferential surface of the distal end portion 32 in the radial direction. As shown in FIG. 28 and FIG. 29, the protrusion 36 penetrates the groove 24 of the rod 2F to further protrude outwardly in the radial direction with respect to the rod 2F. The protrusion 36 enters the groove 24 to be engaged therewith so as to be freely slidable along the longitudinal direction A, and the moveable range of the sharp member (hollow needle) 3F in the longitudinal direction A with respect to the rod 2F is restricted. The protrusion 36 of the advancing sharp member 3F comes into contact with the proximal end of the insulation tip 11 so as to determine the position of the distal end of the sharp member 3F.

Although the respective embodiments and modifications of the present disclosure have been described above, the technical scope of the present disclosure is not limited to the above-described embodiments, and includes configurations in the respective embodiments and modifications within the scope of the claims not departing from the spirit of the present disclosure. It is possible to change the combination of elements, make various changes to each configuration element, or delete each configuration element. For example, the configuration according to any one of above-described embodiments and modifications of the present disclosure may be appropriately combined with each modification of the operation section. The present disclosure is not limited by the above description, but only by the appended claims. 

What is claimed is:
 1. An endoscopic treatment device comprising: a sheath; a tubular hollow needle inserted into the sheath and having a sharp distal end; a rod inserted into the sheath and having a conduit; a shaft attached to a proximal end of the rod and having an internal space communicating with the conduit of the rod; and an operation portion comprising: a slider attached to a proximal end of the shaft; and a lever attached to a proximal end of the hollow needle.
 2. The endoscopic treatment device according to claim 1, wherein the slider and the lever are connected by a ratchet mechanism.
 3. The endoscopic treatment device according to claim 1, wherein the rod is inserted into the hollow needle.
 4. The endoscopic treatment device according to claim 1, further comprising: a distal end cover provided in a distal end portion of the sheath, wherein: a protrusion is provided on an outer circumferential surface of a distal end portion of the hollow needle, and the protrusion engages with a proximal end of the distal end cover due to an operation of the lever.
 5. The endoscopic treatment device according to claim 4, further comprising: a connection portion configured to connect the rod and the shaft, wherein: the connection portion protrudes from the rod in a radial direction, and the connection portion engages with the proximal end of the distal end cover due to an operation of the slider.
 6. The endoscopic treatment device according to claim 5, further comprising: a flange at a distal end of the rod, wherein: a distal end of the rod is positioned at a first position being at a distal end side of a needle tip of the hollow needle when the connection portion is engaged with a proximal end of the distal end cover, and the distal end of the rod is positioned at a second position being at a proximal end side of the needle tip of the hollow needle when the flange is engaged with a distal end of the distal end cover.
 7. The endoscopic treatment device according to claim 1, wherein the hollow needle is inserted into the conduit of the rod.
 8. The endoscopic treatment device according to claim 7, further comprising: a groove extending along a longitudinal axis in a distal end portion of the rod, wherein: a protrusion is provided on an outer circumferential surface of the hollow needle, and a movement range of the hollow needle with respect to the rod is restricted by the protrusion entering the groove and being engaged with the groove so as to be freely slidable along the longitudinal axis.
 9. The endoscopic treatment device according to claim 1, wherein the sheath is formed from a resin.
 10. The endoscopic treatment device according to claim 1, wherein the rod is formed from a metal.
 11. A treatment method comprising: inserting an endoscopic treatment device into a body cavity, the treatment device comprising: an electrode having a hole; and a needle positioned at a distal end side of the electrode and being freely movable with respect to the electrode; forming an incision from a mucosal surface to a submucosa layer by the needle tip; inflating the mucosal surface by injecting fluid until the submucosa layer from the hole of the electrode via the incision; and peeling the submucosa layer while energizing the electrode with a high-frequency current in a state in which the needle is positioned at a proximal end side of a distal end of the electrode.
 12. The treatment method according to claim 11, wherein the fluid is injected until the submucosa layer via the incision in a state in which the needle is stuck in the incision.
 13. The treatment method according to claim 11, wherein the liquid is supplied toward the incision from the hole.
 14. The treatment method according to claim 11, wherein the hole opens at a distal end of the electrode, and the liquid is supplied toward the incision from the hole in a state in which the distal end of the electrode is pressed on the incision.
 15. The treatment method according to claim 11, wherein movement of a distal end of the needle is restricted in a state in which the distal end of the electrode is positioned at the distal end side of the distal end of the needle.
 16. The treatment method according to claim 11, wherein: when the electrode is advanced, movement of the position of the distal end of the needle is restricted in a state in which the distal end of the electrode is positioned at the distal end side of the distal end of the needle, and when the electrode is retracted, movement of the position of the distal end of the needle is restricted in a state in which the distal end of the electrode is positioned at the proximal end side of the distal end of the needle while the electrode abuts on a distal end of the sheath.
 17. An endoscopic treatment device comprising: a sheath; an electrode provided at a distal end side of the sheath and having a conduit extending along a longitudinal axis; and a needle having a needle tip and being freely advanceable and retractable with respect to the electrode, wherein: the needle tip is movable to a first position at a distal end side of the electrode by advancing the needle with respect to the electrode, the needle tip is movable to a second position at a proximal end side of the electrode by retracting the needle with respect to the electrode, the endoscopic treatment device is configured to supply liquid from the conduit in a state in which the needle tip is moved to the first position, and the endoscopic treatment device is configured to energize tissues in a state in which the needle tip is moved to the second position. 